Utility of plasma dehydroepiandrosterone sulphate determination in adrenal incidentalomas

Abstract

To evaluate whether low DHEA-S levels are predictors of cortical origin, benignity and hormonal activity in incidentally detected adrenal masses, thirty-five patients with adrenal incidentalomas were studied. All patients were operated on and the diagnosis was histologically confirmed. Basal endocrine workup included plasma determination of cortisol before and after dexamethasone (1 mg overnight), plasma ACTH (08:00 h), 17-OH-progesterone, testosterone and potassium, standing plasma renin activity and aldosterone, supine and standing plasma noradrenaline and adrenaline. If necessary, we performed dexamethasone suppression tests at low (2 mg) and high (8 mg) doses, or the loperamide test (16 mg os) for evaluation of glucocorticoid activity and the glucagon test (1 mg i.v.) for exploring adrenal medulla function. Plasma DHEA-S was measured in all patients and the results were compared to those obtained in controls matched for age, sex and menopausal status. Suppression of DHEA-S was found in 11 out of 35 patients (31.5%). However, this hormonal finding occurred in 50% of the extracortical adrenal lesions, while in proven cortical adenomas (no. = 19) it was detected in only 5 patients (26.3%). Sensitivity, specificity, diagnostic accuracy and positive predictive value of low DHEA-S in indicating a cortical origin of the mass were 0.27, 0.0, 0.25, and 0.80. In malignancies (no. = 6) low DHEA-S levels were found in 1 out of 2 metastases and never in cortical carcinomas. Sensitivity, specificity, diagnostic accuracy and positive predictive value of low DHEA-S in indicating a benign form were 0.34, 0.83, 0.42, and 0.91. Six out of 19 patients with cortical adenomas showed signs of hypothalamic-pituitary adrenal (HPA)-axis dysfunction. Low DHEA-S levels were found in 50% of adenomas with HPA-axis abnormality and in 15.3% of adenomas without hormonal activity. Sensitivity, specificity, diagnostic accuracy, and positive predictive value of low DHEA-S levels in indicating hormonal activity of the mass were 0.50, 0.84, 0.73, and 0.60. Our data indicate that the association between low DHEA-S levels and adrenal incidentalomas is frequent. Low DHEA-S appears to be a poor predictor of hormonal activity with low sensitivity and specificity in respect of cortical origin and benignity of the mass. In conclusion, our results show that DHEA-S measurement does not offer relevant clinical information in the management of adrenal incidentalomas.

Apparent activities of 21-hydroxylase, 17alpha-hydroxylase and 17,20-lyase are impaired in adrenal incidentalomas

“…Similarly, although subclinical hypercortisolism has been observed in as high as 12% of adrenal incidentalomas (34), only one patient out of seventeen displayed some degree of hypercortisolism. This series is also remarkable for the very low level of DHEA-S that was observed, with no patients displaying normal values for age (6,10,(13)(14)(15)(16)(17)(18).…”

“…Alternatively, there is some evidence for an impaired 11b-hydroxylase activity (12). Finally, a decreased level of dehydroepiandrosterone sulfate (DHEA-S) has frequently been reported (6,10,(13)(14)(15)(16)(17)(18) and could signify a weakened 17,20-lyase activity (19). The aim of this study was, therefore, to define more clearly the apparent activities of these steroidogenic enzymes in adrenal incidentalomas.…”

The Prevalence of 21-Hydroxylase Deficiency in Adrenal Incidentalomas - Hormonal and Mutation Screening

“…It has been demonstrated that patients with bilateral adrenal incidentalomas have signifi cantly increased plasma 17 OHP levels in response to ACTH stimulation compared with those with unilateral tumors. On the other hand, an exaggerated response of 17OHP to ACTH more frequently occurs in patients with bilateral than in unilateral massess ( Bernini et al, 1998 ). In a recent study Pat ó cs et al found a higher ACTH-stimulated plasma 17OHP concentrations in patients with bilateral adrenal massess, although the difference between bilateral and unilateral tumors was not signifi cant ( Pat ó cs et al, 2002 ).…”

Evaluation and Management of Adrenal Masses

“…22 However, in a recent study, the plasma DHEA-S concentration was a poor predictor of hormonal activity. 23 Most centers utilize the overnight 1mg dexamethasone suppression test. If the cortisol level at 8 AM following dexamethasone given the night before is greater than 5 mg/dL, a formal 2-day, low-or high-dose dexamethasone suppression test is indicated to confirm the autonomy.…”